Provider Demographics
NPI:1194833798
Name:RIVER CITY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RIVER CITY MEDICAL GROUP, INC.
Other - Org Name:SACRAMENTO FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:QUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-228-4300
Mailing Address - Street 1:PO BOX 15470
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0470
Mailing Address - Country:US
Mailing Address - Phone:916-228-4300
Mailing Address - Fax:916-382-4202
Practice Address - Street 1:5735 WATT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-4751
Practice Address - Country:US
Practice Address - Phone:916-339-2229
Practice Address - Fax:916-339-2609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER CITY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053751Medicaid
CAZZZ00371ZMedicare ID - Type Unspecified